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When a spree killer commits four brutal murders in 24 hours, the Detectives canvass the streets searching for signs of a madman who exclaims paranoid schizophrenic and twisted religious rhetoric while committing his crimes. Things are made worse when no one can find any connections or pattern to the four murders. As the public cries out for justice, a suspect (Daniel Varney) is caught, and with the help of his wife, the detectives wade through the religious trout. As the case is finally looking like it is going somewhere, they learn a shocking truth which would likely change the course of a now, much too public trial.

The detectives are on the search for a spree killer who is responsible for the death of a prostitute, a promising young woman, and a husband and son. They soon discover that a man named Daniel Varney is responsible for the murders after he turns in a bloody check, but it is soon discovered that he is mentally unstable, suffering from paranoid schizophrenia, because of a severe case of syphilis that had damaged his brain.

Benson told his wife that Daniel has syphilis that eradicated his entire mind. His case was so advance that he probably might have picked it up long before he met Paula. Daniel's wife didn't know that he had syphilis because the life insurance company (which he applied for coverage during a medical exam) didn't inform him about it. His syphilis is so advanced that it's incurable and has destroyed the moral center of his brain. Paula Varney got an answer from the company, confirming that they knew that Daniel had long-period syphilis.

The CEO of the life insurance company is arrested for reckless endangerment as he didn't inform the health department about Daniel Varney's communicable disease, both of which would have led to his treatment and cure before it was too late and prevented the carnage he caused (which, at the time the disease was originally caught, would have taken no more than one dose of penicillin). A deal is made by A.D.A. Cabot forcing the company to report any and all communicable diseases to both the health department and the families concerned; as well as settle with the Varneys and families of Daniel's victims, even though it will cost them millions of dollars.

Daniel is found not competent to stand trial, because of the irreversible disease and he is placed under custody of the office of mental health, to be committed to a secured mental health facility until he is competent to stand trial, which will likely not happen before his death due to the advanced state of the disease, as well as the irreparable damage that it has already done.

Deleted scenes from this episode included a scene in which DetectivesElliot Stabler and Olivia Benson receive a promotion. Stabler goes up from Detective 2nd grade to Detective 1st grade, and Benson goes up from Detective 3rd grade to Detective 2nd grade.

Scourge is the last episode before the September 11, 2001 attacks on the World Trade Center, the Pentagon and the attempted attack on either the White House or Capitol Building.